Author: By Frances K. Grossman

Date: SUNDAY, April 26, 1998

Page: L1

Section: Books

Kim Kluger-Bell found herself dazed and despairing after her second miscarriage, which followed two ectopic pregnancies and four in vitro fertilization failures. Despite her knowledge as a family therapist, she was unable to find anything written that acknowledged that her intense and enduring feelings were legitimate. She struggled with overwhelming shame that she was having these powerful and apparently atypical reactions. Ultimately, she resolved that when she got through the dark place she was in, she would write the book that she could not find. ``Unspeakable Losses'' is that book.

During the following year, she continued to listen to her own clients struggling with pregnancy losses, and interviewed others who had especially difficult experiences with such common events as failure of in vitro fertilization, miscarriage, stillbirths, and voluntary abortions. She also interviewed physicians, therapists, counselors and others who provided services to these individuals. The heart of her book is her sensitive and thoughtful descriptions of the experiences of individuals who have suffered deeply from such losses, usually in shamed silence.

Clients often came to her with seemingly inexplicable problems in living or symptoms which upon exploration turned out to be direct derivatives of deep and shame-bound pain, hidden because of the cultural message that these pregnancy losses are trivial and should be taken in stride. Often, clients did not know they were reacting to those losses until they had the space in therapy to explore their feelings in depth.

``Composing Myself'' is harder to read because it is so beautifully written and because the story Fiona Shaw has to tell is at points so starkly harsh and painful. Shaw was a young British writer, living her life with no more nor less difficulty then most of us, when several days after the birth of her much-wanted second child, she started to feel depressed. Her precipitous slide continued, marked by growing inertia, panic, and relentless self-contempt until, 10 days after the birth, she and her baby daughter were hospitalized in a psychiatric facility.

Her experiences with the British National Health Service are horrifying to read, even though the doctors and nurses were clearly trying to be helpful in the way they believed best. From the beginning, Shaw was desperate to understand what was happening to her and why, and believed the answers and her recovery were embedded in her life. All of her caretakers had an exclusively biological orientation, and did not support any therapy other than medication and electroshock, of which she eventually had 16 sessions. It is exquisitely painful to read how desperately she tried to get the professionals responsible for her care to help her understand and know all of her story.

Eventually Shaw found a psychotherapist in the private sector. Her therapy, and writing this book, helped her reclaim her history and her life. The story she came to know is of a childhood with many good aspects but too much pain and complexity for one child to integrate unaided. The apparently successful self that she had created out of this history, in the context of her own biological strengths and vulnerabilities, was shattered by the birth of her second daughter. She believed from the beginning, even in the depth of a psychotic depression, that ``the terrifying iceberg of emotions that I had been struck by since Jesse's birth had its deepest parts floating way down out of sight in my own early life.'' Despite the certainty of her biologically oriented caretakers, she believed that for her to move beyond the depression, she needed to reexamine the self she had been, and create a larger frame with a more adult understanding.

Both of these authors join the growing chorus of voices who insist that their experiences, their pain, be heard. Called the ``victim movement'' by disparagers, these are individuals and groups who no longer accept the cultural rules about what pain is legitimate and whose sorrows should be held in silence.

Kluger-Bell attributes the silencing of pain around pregnancy losses to America's youth-oriented and ``insistently optimistic'' culture that refuses ``to acknowledge the inevitability of death, the necessity of loss. . . . We seem to believe that given enough effort and will power we can conquer anything. Wanting to believe this as fervently as we do makes us tend to turn away from the sick, the dying and the grieving. We get angry with them and wish they would go away because they are reminders, constant reminders, of the limitations of our power, of the inevitability of our own demise.''

Shaw's story makes it clear that silencing is not just an American phenomenon, but at least includes our close relations, the British, and that some of the silencing is done by mental health professionals, who often, in the guise of science, carry out the wishes of the culture.

It is striking to me that these books are published at a time when this culture is rapidly backing away from its support of psychotherapists who take the time to listen to people's pain. With the advent of financially driven managed care, with the ``false memory'' movement threatening therapists who listen to their patients and sometimes hear stories that many in the culture do not want to know, and with the mental health professions scurrying to find ever briefer ways to remove people's symptoms without having to listen to their stories, there will inevitably be more individuals like those described in these books.

These authors insist on being heard, and need to be read, not just by those struggling with the particular losses or reactions they describe, but by all of us concerned about the direction of our culture and the life of our souls.